This document discusses how infectious diseases transmit through aerosols and droplets, and strategies for controlling airborne transmission in indoor environments. It explains that aerosols can travel farther than droplets and be impacted by HVAC systems. Mathematical models are presented for airborne infection risk based on factors like exposure time and ventilation. Research needs are identified like determining if a virus transmits through aerosols, its natural decay rates, and exposure thresholds. Strategies discussed include increasing ventilation and filtration, controlling temperature and humidity, and using upper-room UVGI. Engineers can help identify vulnerabilities and approaches to interrupt air supply to shelter locations. More research is needed on virus transmission through aerosols.

1. College of Mechanical Engineering
Peng Xu, PhD, PE, MBA
Professor, Tongji University
Shanghai, China
English translation and voiceover by
Slipstream Group, Inc.
Madison, Wisconsin USA

2. How Infectious Diseases Transmit

3. How Infectious Diseases Transmit
Illustration of the aerobiology of
droplets and aerosols produced
by an infected patient：
▪ The patient generates droplets
by coughing or sneezing
▪ Droplets evaporated to become
droplet nuclei
▪ Droplets fall due to gravity
▪ Droplets land on a surface and
become desiccated. It can be
ejected back into the air by bed-
making activities.

4. How Infectious Diseases Transmit

5. How Infectious Diseases Transmit
Why we care about viruses transmitting through aerosols?
▪ Air ventilation won’t have a significant impact on the concentration, velocity,
and direction of the respiratory droplets with bigger sizes [1]
▪ Aerosols travel a relatively long distance and can be significantly impacted by
the building heating, ventilating, and air-conditioning (HVAC) system [2]
[1] Siegel J.D., E. Rhinehart, M. Jackson, and L. Chiarello. 2007. 2007 Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings. Atlanta: Centers for Disease Control and Prevention, The
Healthcare Infection Control Practices Advisory Committee.
[2] ASHARE Position Document on Airborne Infectious Disease

6. Mathematical Model of Airborne Infection
𝑪 = 𝑺 𝟏 − 𝒆−𝑰𝒒𝒑𝒕/𝑸
C = number of new infections;
I = number of infectors;
S = number of susceptibles;
q = number of doses of airborne infection added to the air;
p = pulmonary ventilation per susceptible; typically 0.6 m3/h;
t = exposure time, typically 8 hours;
Q = volume flow rate of fresh or disinfected air (m3/h)
Tuberculosis: 1.25~249 qph
Measles: 5,480 qph

7. Characteristics of Transmission Through Aerosols
Transmission Types Characteristics Disease
Obligate
Only transmit through aerosols, aerodynamic
diameters of the particles between 1~ 5 𝜇m
Mycobacterium
tuberculosis
Preferential
Transmit through multiple routes,
predominantly by aerosols
Measles
Chicken pox
Opportunistic
Transmit through multiple routes, can by
aerosols when in favorable conditions
To be determined
Roy, C.J., and D.K. Milton. 2004. Airborne transmission of communicable infection—The elusive pathway.
New England Journal of Medicine 350:17.

8. My Research on Mycobacterium
Tuberculosis Transmission

9. Common flu virus and rhinovirus (common cold),
can transmit through aerosols
Flu virus can transmit through aerosols, but it is not the main
route

10. ▪ In an Alaska Airline airplane, 72% of the 54 passengers were infected with flu,
due to the airplane’s recirculated air ventilation system.[1]
▪ In the 1986 H1N1 period, researchers arranged the susceptibles to be over 6.5
feet (2 meters) from the infected patient; the susceptibles were still infected.[2]
▪ A SARS Coronavirus outbreak in a high-rise building in Hong Kong
(Amoy Gardens) was due to the exhaust fans in restrooms [3]
[1] Moser, M.R., T.R. Bender, H.S. Margolis, G.R. Noble, A.P. Kendal and D.G. Ritter. 1979. An outbreak of influenza aboard
a commercial airliner. American Journal of Epidemiology 110(1):1–6.
[2] Klontz, K.C., N.A. Hynes, R.A. Gunn, M.H. Wilder, M.W. Harmon, and A.P. Kendal. 1989. An outbreak of influenza
A/Taiwan/1/86 (H1N1) infections at a naval base and its association with airplane travel. American Journal of Epidemiology
129:341–48.
[3] Li, Y., H. Qian, I.T.S. Yu, and T.W. Wong. 2005a. Probable roles of bio-aerosol dispersion in the SARS outbreak in Amoy
Gardens, Hong Kong. Chapter 16. Population Dynamics and Infectious Disease in the Asia-Pacific. Singapore: World
Scientific Publishing.
Cases that viruses transmit through aerosols

11. Ventilation &
Air Cleaning
Humidity Control
Emergency
Planning
HVAC system design,
operation, and maintenance
strategies
1. Increase outdoor air
2. Control airflow direction
3. Control room air
differential pressure
4. Personalized ventilation
5. Use high-efficiency filter
6. Utilize UVGI

12. Research show that controlling air relative humidity may reduce
transmission of certain airborne infectious organisms
Possible Relative
Humidity Impact
The ASHRAE document does not make a broad recommendation on
indoor temperature and humidity. Industry practitioners should make
their own decisions on a case-by-case basis.
Ventilation &
Air Cleaning
Humidity Control
Emergency
Planning
1. More humid air will slow the
evaporation of large droplet into
droplet nuclei
2. Breathing dry air could cause
desiccation of the nasal mucosa,
making the person more susceptible
to respiratory virus infections
3. Humidity may affect the viruses’
viability or toxicity

13. ▪ Coronavirus and flu virus can survive
longer in cold and dry environments
▪ The transmission rates are also higher
Room Temperature and Humidity
and Coronavirus Viability
Lowen, A.C., S. Mubareka, J. Steel, and P. Palese. 2007. Influenza Virus Transmission Is Dependent on Relative Humidity
and Temperature. PLOS Pathogens. 3(10):e151.

14. Issues
Ventilation &
Air Cleaning
Humidity Control
Emergency
Planning
▪ Nobody knows what level of dilution ventilation is needed to
decrease the droplets or droplet nuclei generated by patients to
prevent their transmissions
▪ It is essential to control room differential pressure (DP) and the
direction of airflow. Isolation rooms should be kept at negative DP,
while rooms for people with low immunity should be kept at positive
DP.
▪ Personalized ventilation systems may prevent virus transmission
through aerosols, but this has not been validated.
▪ Adding highly efficient particle filtration to central ventilation
systems may reduce the number of infectious particles in the air
▪ Two applications of Ultraviolet Germicidal Irradiation (UVGI):
• Installation into air handlers and/or ventilating ducts
• Irradiation of the upper air zones of occupied spaces with
shielding of the lower occupied spaces

15. How engineers can help?
Ventilation &
Air Cleaning
Humidity Control
Emergency
Planning
▪ Identify vulnerabilities with air intake, wind direction, shielding
▪ Identify building systems and safe zones in the general building
environment
▪ Identify approaches to interrupting air supply to designated
“shelter-in-place” locations
▪ Identify co-horting possibilities for pandemic situations so that
whole areas of a hospital may be placed under isolation and
negative pressure

16. Strategy
Occupancy Categories Applicable
for Consideration*
Application
Priority
Research
Priority
Dilution ventilation All High Medium
Temperature and humidity All except 7 and 11 Medium High
Personalized ventilation 1, 4, 6, 9, 10, 14 Medium High
Local exhaust 1, 2, 8, 14 Medium Medium
Central system filtration All High High
Local air filtration 1, 4, 6, 7, 8, 10 Medium High
Upper-room UVGI 1, 2, 3, 5, 6, 8, 9, 14 High Highest
Duct and air-handler UVGI 1, 2, 3, 4, 5, 6, 8, 9, 14 Medium Highest
In-room flow regimes 1, 6, 8, 9, 10, 14 High High
Differential pressurization 1, 2, 7, 8, 11, 14 High High
1. Health care (residential & outpatient)
2. Correctional facilities
3. Educational < age 8
4. Educational > age 8
5. Food & beverage
6. Internet café/game rooms
7. Hotel, motel, dormitory
8. Residential shelters
9. Public assembly & waiting
10. Transportation conveyances
11. Residential multifamily
12. Retail
13. Sports
14. Laboratories
*Occupancy
Categories
Airborne Infectious Disease Engineering Control Strategies: Occupancy
Interventions and Their Priority for Application and Research

17. Urgently needed: experiments on animals and mathematic model
parameters determination
▪ Does it transmit through aerosols? (experiments on animals)
▪ The natural decay rate of the virus viability (various environments)
▪ Exposure threshold for virus infection (susceptibles)
▪ Rates of virus release by infected patients at different stages and by
various activities
What is the indoor environment control
parameter?
CO2 level between 550–1000 PPM
Problems need to be resolved now: risk assessment of COVID-19
coronavirus transmission through aerosols in public spaces

18. Email: xupeng@tongji.edu.cn
College of Mechanical Engineering
Thanks
slipstreaminc.org